Mia R Sellars, DMD
Individual provider Active NPI Dentist · Evarts, KY
NPI 1609971969 · NPPES record last updated Oct 21, 2015
Key facts
- NPI
- 1609971969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6865 (KY)
- Practice address
- Clover Fork Clinic
101 Chad St
Evarts, KY 40828-0039 - Phone
- (606) 837-2108
- Fax
- (606) 837-9389
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6865 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6865 | KY | Yes |
Addresses
Primary practice location
Clover Fork Clinic
101 Chad St
Evarts, KY 40828-0039
Mailing address
Clover Fork Clinic
PO Box 39
Evarts, KY 40828-0039
Phone (606) 837-2108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60001864 | Medicaid | KY |
Other providers in Evarts, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.